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The Boston Globe

Opinion

JOANNA WEISS

Health care costs can bite

Riddle me this, health care consumers, watching from the sidelines as our politicians ponder the untenable rise in medical costs. How are we, the people, supposed to do our part to keep those costs from spiraling out of control? How are we supposed to make the right choices? How much choice do we really have?

Consider the case of a family of four, which will (cough) remain nameless. On a recent night, while the children slept in a nearby room with an open door, the parents roused from their slumber to hear something rattling against their bedroom window. It was a bat. In a brief frenzy at 1 a.m., it was captured and released.

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The next morning, the father recalled that, a few days earlier, he’d seen something in the kitchen that looked like bat poop. And the mother, who is mildly paranoid by nature, thought about rabies.

The mother called her pediatrician’s office, where a nurse called the state disease control office, then called back with a report. The state said the parents should, unequivocally, get the series of shots that make up the rabies vaccine. They had been sleeping; they might have been bitten without knowing it; a bat bite is like a spider bite, hard to detect.

As for the kids, the nurse said, it was up to the parents. The chance they’d contracted rabies was minuscule, something in the order of 1 in 400 million. On the other hand, rabies was fatal. The doctor’s official recommendation was: Give your kids the shots “if it will help you sleep at night.”

An absurdly low risk versus certain death. How could parents make a rational decision?

They chose the shots.

At this point, the parents were still thinking about costs. They had a high-deductible insurance plan, designed to make patients consider health and money simultaneously. Getting the shots at a doctor’s office would surely be the cheapest option.

But only the mother’s primary care practice had access to the shots — and said it couldn’t, for administrative reasons, give those shots to the father or kids. The father’s doctor referred him to the emergency room. The insurance company offered some names of urgent care centers to call, but they all turned out to be ERs, too. The father considered switching primary care doctors, just so he could go to an office.

Meanwhile, the pediatrician’s office recommended the emergency room of a world-renowned teaching hospital. Since this was a simple matter of shots, the parents asked if they could go to their local hospital, instead. It turned out they could. So the mother called the hospital to ask how much it would cost.

“I’ve heard it’s very expensive,” a helpful woman in billing said.

“How expensive?” the mother asked. “A few hundred dollars?”

The woman in billing put her on hold. Then she returned to the phone with an educated guess: Something like $2,000 per person.

This was a shocking number, but it also represented freedom. The family had already used up a good half of its $3,000 deductible this calendar year: a case or two of strep (lab work), a suspicious bulge (imaging), a doctor-recommended ER visit for a 3-year-old boy who was holding in his pee. Bills had arrived at the house, listing costs and insurance adjustments. One needed to be both an accountant and a medium to decipher them. The parents, being neither, had simply paid the totals.

Now, the calculation had changed. The instant one child set foot in the ER for rabies shots, the family deductible would be met. All health care, for the rest of the calendar year, would be absolutely free. The father cancelled his plans to switch doctors. He might as well just go to the ER, for convenience’s sake.

The visit went smoothly. The hospital staff was warm, kind and efficient. The multiple shots weren’t fun, but they were fast. Afterward, the kids got orange Popsicles and the 3-year-old raced through the emergency room, giggling, with his pants falling down.

For the rest of 2012, the parents, if they wanted, could to go the emergency room every time they needed basic care. They won’t. But they’re considering their health care writ large, planning to get a few smallish, quasi-elective procedures they might have otherwise delayed. Why not? For the rest of the year, containing costs is someone else’s problem.

Joanna Weiss can be reached at weiss@globe.com. Follow her on Twitter @JoannaWeiss.

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